Articles and other writing

Although the subjects covered here are the important issue, I have noticed on various sites, skepticism about my qualifications. “Anyone could sound off. Is he an expert?” Stuff like that.

Answer: 1) I do like to sound off as much as the next person. Maybe more. 2) No, I am not an “expert.” But that is only strike two. I freely acknowledge that without an academic appointment, and not exactly a house hold name, I have to “sell” the legitimacy of these articles.

Which is a problem. Heaping praise on myself goes against my upbringing. It’s embarrassing. But if it lures someone flying through the web to want to come in for a landing, the compliments I have gathered here will have served a purpose. Please note below the variety of notable and thoughtful people who have found these articles valuable.

This still doesn’t qualify me as an “expert,” but the truth is that term is silly. Given the point we are at in our knowlege of the brain, I just don’t get the mentality of someone who accepts designation as an expert, or those who acclaim others with that description. The theme of many of these article is that, considering how much we still don’t understand, our steps forward should be tentative, investigative, not closed off by the chilling effects of authority.

Or is that the point? It is understandable that when we don’t know something that we need to know, we turn to “experts”. Some of their findings are helpful. Some are not. Some are completely mistaken, and could only have been written by someone with very little hands on experience . The term is particularly often used by those paid and delivered by large pharmaceutical companies, who, understandably, don’t want to publicize the knowledge we need, but don’t have. Rather, they prefer to present an “expert” with an answer and remedy. The fact is that when we truly have explanations for a phenomenon we simply have information. When we don’t we have expert opinion.

The trap in the recent mindset is that waving science as a banner, its virtues can act like a smokescreen. The language, the prestige, the trappings of science can be so distracting that science’s core value is overshadowed, absolute clarity about what is known and not known. We are all waiting for the day when we have scientifically answered the important mysteries confounding us today, but until then it is dishonest to act as if that day has arrived.

A Reevaluation of the Relationship between Psychiatric Diagnosis and Chemical Imbalances. Scott Peck (The Road Less Traveled) described this article “as one of the few superlative papers he had read in his career as a psychiatrist.” Psychologist, Lauren Slater (Prozac Diary) wrote to me that she had printed it up for everyone at the clinic where she then worked. On the google search term “psychiatric diagnosis” it was number 1 for four years. It was based on a talk given in 1999 as the featured speaker at the University Of Alabama’s Psychiatry Department’s Grand Rounds.

As opposed to treatment strategies based on diagnoses, this article gives specific examples of medications used to address psychopathology that may, or may not, be listed as symptoms of a particular syndrome. It continues arguments made in earlier papers (see below) that 15 minute once a month med checks cannot be considered optimal treatment. It gives examples of sensible strategies that psychiatists can consider only when they know their patient well, increasingly a rarity.

On the Banality of Positive Thinking Takes issue with the assumptions and practices of cognitive behavioral therapy. ( From Psychiatric Times July 2001) Group Therapy Perspective included this article in their mailing to the members of the Group Therapy Association. Not sure what the connection to group therapy is but some editor apparently thought it should be read by their members. (unfortunately Psychiatric Times now requires a login but it appears to be free)

Mood Stabilizers and Mood Swings: In Search of a Definition An article challenging, the recent extraordinary overdiagnosis of bipolar disorder. (Psychiatric Times October 1999) James Phelps M.D. in the annotated references at his wonderful site described this article as “an important historical touchstone.” Recently, Allen Frances M.D. , chair of the DSM IV Task Force referred to one of DSM IV’s unintended consequences as “false epidemics“, a sudden increase in the diagnosis of autism, bipolar disorder and ADHD. (unfortunately Psychiatric Times now requires a login but it appears to be free)

The Fear of Death. An argument with Freud, and a reconsideration of his ideas. It is an attempt to introduce the obvious into psychoanalytic theory, that the fear of death plays a seminal role in our psychology. Although personally Freud had an enormous fear of death, he dismissed its importance in his theories about our motivations. This despite the fact that it was, by far, his most pressing neurotic symptom. It was the lurking monster in his most frightening and famous dream, the Dora dream. He looks into his patient Dora’s throat and discovers a horrifying lesion that he had missed. Like the Pharoah questioning Joseph, he has to understand what that dream meant.

It takes hold of him, drives him to work on what will become “The Interpretation of Dreams.” The extent to which Freud had no choice about this undertaking can best be appreciated from his letter to Wilhelm Fleiss. He describes a process of working “to which every effort of thought has to be given and which gradually absorbs all other capacities and the ability to receive impressions– a sort of neoplastic substance that enters into one’s humanity and then replaces it. With me it is even more so. Work and earning are identical with me–so that I have become wholly carcinoma…my existence from now on is that of a neoplasm.” (Jones 1953)

A strange image describing one’s work. Work that was later to be recognized as inspired. Eventually, what his dream meant became clear. The location of the lesion in the back of Dora’s throat was to be the exact spot that Freud’s throat cancer developed many years later. He had looked into the mouth of death. The cancer eventually killed him.

“The Interpretation of Dreams” is usually considered the birth of psychoanalysis. Freud called dreams “the royal road to the unconscious.” He brilliantly wrestled with what he found there, asked many of the right questions. He came up with many right answers. If his search for clarity about dreams, and the working of the unconscious, was induced by the Dora dream, what influence did it have on the body of his work ? Certainly, many people are awakened by a dream in which they are about to die. For many, appreciating the reality of death, makes life more meaningful. It makes one’s relationships, one’s work, one’s discoveries all the more valuable.

Nevertheless, we are still left with this peculiarity . How could someone describing their work as a cancer, with an openly admitted powerful fear of death, dismiss the fear of death as a major part of our psychology.

I have no answer, but clearly, he was wrong. It is not hard to find the fear of death constantly addressed in men’s thinking. It is usually transformed, put in a positive perspective. The best example is religion; to get rid of the fear of death, the Aztec’s practiced human sacrifice to appease the angry Gods.

Century after century, Christians worried about their future after death. Transformed by religious doctrine, the fear of death tormented them with dark possibilities. They were pious (or resolved to follow that path) in order to assure a place in heaven. Understandably since few men are entirely innocent, they were terrified that their moments of giving into temptation might land them in hell. Immortality has been the cornerstone of Christianity, its most powerful ideal. Hundreds of millions of Bibles have been read, studied and held dear. (in contrast to this book) All because Christ promised his believers would live forever.

Today we see a revival of that passion. Isis members have been willing to fight ferociously and fearlessly, even offer themselves for suicide missions, with the belief they will achieve the opposite result of their fear. They are guaranteed a heaven that is very different than Muslim reality a strictly imposed sexual suppression. At last their temptations can be fulfilled. Not one, not two, 72 virgins await them in heaven after they die. It beats the promises of Jesus where heaven has never been adequately imagined. Angels playing harps? Is this the best reward God can offer?

Modern Western secular consciousness is quite different. Since the existence of God is dubious, happiness in this life is all we have. So that is what we pursue. The fear of death is resolved differently. Virtuous behavior is redefined (exercise, weight loss, lower cholesterol, and the most virtuous of all, “organic” food). This belief system is transformative in religion’s usual ways. Fantastic beliefs are bought and believed, logic and evidence tossed away.

That is not a problem. Whatever bargaining, compromising, and self deception is required, the mind is up to the task. Faith and spirituality invariably trumps common sense.

And as might be expected, as in all religions, people can go over board. In its modern incarnation some people become fanatical about the organic purity of their food. They become “glaat” kosher. Many become sanctimonious, outraged by the lack of healthy eating by others. Many do an inventory of their soul. Only in this case their virtues and vices are measured by whether or not they gave in to temptation and ate that slice of pizza, or whether they forgoed their morning workout.

Whatever language we use, the fear of death insinuates itself into our consciousness, demanding solutions. Unfortunately, this book doesn’t offer a solution to the basic problem. As Woody Allen put it “I don’t want to be immortal because of my work. I want to be immortal by living forever.”

ADHD and Other Sins of Our Children This is the original, far more lengthy article on ADHD. Among other things it includes a discussion of false scientific claims for the biological basis of ADHD which is not a part of the shorter version. It wanders quite a bit, ( self indulgently) but the reader who sticks it through to the end will be rewarded with a good many insights about the nature of psychiatric knowledge and perspectives, as well as an extraordinarily important subject (to me!) growing up in Queens during the 50′s. Given my personality, having difficulty getting in step with others, and reciting verses properly, why didn’t I get ADHD?

Narcissism as a Function of Culture Anna Freud had this to say about this article: “I read immediately what you have written and found it very interesting and convincing… I have searched for the right words to describe the processes which underlie the young people’s attitudes, but I was not able to find them. I believe that you have done much better in this respect and I find myself fascinated by your elaborations…” She had it published in the 1977 yearly edition of the Psychoanalytic Study of the Child.

Naricissism and Social Disorder Yale Review 64:527-543 (1975)

After Lisa Based on a true story. Aimed at the horrible psychiatric care deliberately instituted for the purpose of insurance company profit. The first few chapters of the novel.